Prostate and PSA: No Longer Recommended

It was once thought that a PSA (Prostate-Specific Antigen) test should be routinely (yearly or so) given to all men over 40 years old. This was suggested to reduce the incidence of prostate problems as well as early detection of prostate cancer.

I have recommended for many years that this testing was not as important for most of my patients as the media and allopathic medicine were claiming. Not only has it been proven to not be that accurate in determining a prostate problem (including prostate cancer), it was also shown to lead to many false positive and thus unnecessary biopsies. The biopsies were sometimes followed by medical complications (like infections) and even more commonly psychological trauma, which made more difficult to warrant the PSA tests.

Members of the American Urological Association (AUA) recently got together and made a series of new recommendations concerning prostate cancer screening. They now discourage screening men who are at average-risk under the age 55.

The AUA suggests caution when making a decision to go through with the screening and to weigh the benefits against the potential harms.

 “It was stressed that it was important to consult a doctor about whether being screened is the right decision for men in general especially before the age of 55. Instead the old recommendation of encouraged healthy men over the age of 40 to consider PSA screening.”

Why has the AUA changed its recommendations regarding PSA screening?

Even though PSA screening may help prevent a small percentage of prostate cancer deaths, it can also be the cause of painful biopsies in “healthy” men, along with some other unnecessary treatments. Researchers from John Hopkins University reported in The Journal of Urology (November 2011 issue) that prostate biopsies are associated with a 6.9% hospitalization rate within 30 days of the procedure because of complications.

Dr.H. Ballentine Carter (Urologist), the chair of the panel, who wrote the new guidelines, said: “There really was no high-level evidence supporting the use of screening with PSA.”

He added that while the general public may be enthusiastic about PSA screening “the idea that screening delivers benefits may have been over exaggerated.”

Carter added: “I look upon this guideline… as the beginning of a targeted-based screening.” Mentioning that “instead of a one-size-fits-all approach, we’re trying to emphasize that there is a group of men between age 55 and 69 that are much more likely to benefit.”

Men above the age of 70 who are only expected to live 10 or 15 more years “are not advised to be screened”.

The American Cancer Society estimates that close to 239,000 men are expected to be diagnosed with prostate cancer this year, with an estimated 30,000 dying from the disease.

Carter said: “The evidence for the benefits of prostate cancer screening was moderate, but the quality of evidence on the harms was high. I think men need this information, they deserve to have this information and when they get it, some men will take the same information and decide they want to get screened” and others won’t”

It’s very important that men are aware of the possible harm that PSA testing can lead to, as well as the possible benefit of it being able to detect cancer.

Many experts now agree with these new guidelines, but express concern about the impact it will have on doctors and their patients.

There are other more accurate tests that have been employed by some. A study done 2 years ago at UCLA’s Jonsson Comprehensive Cancer Center, a test for prostate cancer called A+PSA assay, which measures levels of PSA and six specific antibodies found in the blood of men with prostate issues to be more sensitive and more specific than the conventional PSA test used.

Last year researchers reported in the New England Journal of Medicine (March 2012 issue) that while PSA testing reduces prostate cancer mortality, it does not appear to reduce all-cause mortality.

For almost 2 years, the USPSTF (US Preventive Services Task Force) recommended against PSA-based screening for prostate cancer. They emphasized that men without symptoms presence should not be tested.

The USPSTF wrote:

“The evidence is convincing that PSA-based screening programs result in the detection of many cases of asymptomatic prostate cancer. The evidence is also convincing that the majority of men who have asymptomatic cancer detected by PSA screening have a tumor that meets histological criteria for prostate cancer, but the tumor either will not progress or is so indolent and slow-growing that it will not affect the man’s lifespan or cause adverse health effects, as he will die of another cause first.”